Interchangeable surgical instrument

ABSTRACT

A robotic medical system comprises an instrument driver having a driver shaft, a driver cable slidably disposed through the shaft, and a driver coupling member respectively mounted to the driver cable, and an instrument having an instrument shaft, an end effector, an instrument cable slidably disposed through the shaft for actuating the end effector, and an instrument coupling member mounted to the instrument cable. The robotic medical system further comprises a storage chamber having a passage that stores the instrument, a drive unit coupled to the instrument driver, and an electric controller configured for directing the drive unit to distally advance the instrument driver within the passage of the storage chamber and engage the driver coupling member and instrument coupling member, and for directing the drive unit to proximally retract the instrument driver within the passage of the storage chamber and disengage the driver coupling member and instrument coupling member.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/077,233, filed Feb. 15, 2002, now U.S. Pat. No. 7,297,142 which is acontinuation-in-part of U.S. application Ser. No. 10/034,871, filed Dec.21, 2001 (now U.S. Pat. No. 6,810,281), U.S. application Ser. No.09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112), which is acontinuation of U.S. application Ser. No. 09/746,853, filed Dec. 21,2000 (now U.S. Pat. No. 6,692,485), which is a divisional of U.S.application Ser. No. 09/375,666, filed Aug. 17, 1999 (now U.S. Pat. No.6,197,017), which is a continuation of U.S. application Ser. No.09/028,550, filed Feb. 24, 1998 (now abandoned). The application Ser.No. 10/077,233 is also a continuation-in-part of U.S. application Ser.No. 09/783,637, filed Feb. 14, 2001 (now abandoned), which is acontinuation of PCT/US00/12553, filed May 9, 2000, which claims thebenefit of priority from U.S. Application Ser. No. 60/133,407, filed May10, 1999. The application Ser. No. 10/077,233 is also acontinuation-in-part of PCT/US01/11376, filed Apr. 6, 2001, which claimspriority from U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000(now U.S. Pat. No. 6,692,485, and Ser. No. 09/827,503, filed Apr. 6,2001 (now U.S. Pat. No. 6,432,112). The application Ser. No. 10/077,233is also a continuation-in-part of U.S. application Ser. No. 09/746,853,filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), and 09/827,503, filedApr. 6, 2001 (now U.S. Pat. No. 6,432,112). The application Ser. No.10/077,233 is also a continuation-in-part of U.S. application Ser. No.09/827,643, filed Apr. 6, 2001 (now U.S. Pat. No. 6,554,844), whichclaims priority to U.S. Application Ser. Nos. 60/257,869, filed Dec. 21,2000, and 60/195,264, filed Apr. 7, 2000, and is also acontinuation-in-part of PCT/US00/12553, filed May 9, 2000, from whichU.S. application Ser. No. 09/783,637, filed Feb. 14, 2001 (nowabandoned), claims priority.

The application Ser. No. 10/077,233 also claims the benefit of priorityfrom U.S. Application Ser. Nos. 60/332,287, filed Nov. 21, 2001,60/344,124, filed Dec. 21, 2001, 60/293,346, filed May 24, 2001,60/279,087, filed Mar. 27, 2001, 60/313,496, filed Aug. 21, 2001,60/313,497, filed Aug. 21, 2001, 60/313,495, filed Aug. 21, 2001,60/269,203, filed Feb. 15, 2001, 60/269,200, filed Feb. 15, 2001,60/276,151, filed Mar. 15, 2001, 60/276,217, filed Mar. 15, 2001,60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001,60/257,816, filed Dec. 21, 2000, 60/257,868, filed Dec. 21, 2000,60/257,867, filed Dec. 21, 2000, and 60/257,869, filed Dec. 21, 2000.

The application Ser. No. 10/077,233 further is a continuation-in-part ofU.S. Application Ser. Nos. 10/014,143 (now abandoned), 10/012,845 (nowU.S. Pat. No. 7,169,141), U.S. Ser. No. 10/008,964 (now abandoned),10/013,046 (now abandoned), 10/011,450 (now abandoned), 10/008,457 (nowU.S. Pat. No. 6,949,106), 10/008,871 (now U.S. Pat. No. 6,843,793),10/023,024 (now abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683,10/011,449 (now abandoned); 10/010,150 (now U.S. Pat. No. 7,214,230),10/022,038 (now abandoned), and 10/012,586, all filed on Nov. 16, 2001now U.S. Pat. No. 7,371,210.

This application is also related to copending application Ser. No.11/762,758. The entire disclosures of the above applications areexpressly incorporated herein by reference in their entirety.

BACKGROUND OF THE INVENTION

The present invention relates in general to medical instrumentation.More particularly, the present invention relates to a surgicalinstrumentation system that enables the interchange of any one of anumber of different surgical instruments at an operative site.

In open surgery a surgeon uses a variety of different surgicalimplements with the total number that are used being a function of theparticular operation being performed. For the most part theseinstruments or implements are hand held devices directly held andmanipulated by the surgeon through the open incision. Typical surgicalinstruments include forceps, needle drivers, scissors, scalpels, etc. Anumber of different instruments or implements may be used during anoperation depending upon the complexity of the medical procedure beingperformed, and even a greater number of instrument exchanges occur.Thus, a great deal of time may be spent during the surgery simply inexchanging between different types of instruments.

In minimally invasive surgery (MIS) there is likewise a requirement,depending upon the particular surgical procedure, to exchangeinstruments or implements during a medical procedure. The primarydifference in minimally invasive surgery is that the incision orincisions are relatively small, typically 5 mm to 10 mm in diameter, incomparison to open surgery. Also, in current MIS instrumentation, suchinstruments as forceps, scissors, etc., are inserted into the body atthe end of long slender push rods actuated by the surgeon from outsidethe patient. Due to the size and increased complexity of theseinstruments it may be even more difficult to carry out an exchange dueto the need to extract and re-insert through a relatively smallincision.

Both open and MIS procedures involve control of the instrument directlyby the human hand. In the case of open surgery, of course, the surgeondirectly holds and manipulates the instrument, while in MIS the operabletool (scalpel, scissors, etc.) is controlled by hand, but through sometype of mechanical transmission that intercouples from outside thepatient to an internal operative site.

In more recent years computer control of instrumentation systems hascome into being, typically referred to as robotic surgical systems, inwhich a surgeon controls an instrument carrying an end effector from aremote site, and through an electronic controller or the like. Theserobotic systems do provide an improvement in the dexterity with whichmedical procedures can be performed. However, even in these moreadvanced systems there is still a need to manually exchange instrumentsduring a procedure.

Accordingly, it is an objective of the present invention to provide asystem and associated method for the ready exchange or interchangebetween a plurality of different instruments at an operative site,whether it be in connection with open, MIS, robotic, or other types ofsurgical systems, apparatus, or procedures.

BRIEF SUMMARY OF THE INVENTION

In accordance with a first aspect of the present inventions, a medicalinstrument assembly is provided. The medical instrument assemblycomprises an instrument driver having a driver shaft, a driver cableslidably disposed through the driver shaft, and a driver coupling member(e.g., a hook) respectively mounted to the driver cable. In oneembodiment, the instrument driver has at least one slot on the drivershaft in which the driver coupling member is disposed. The medicalinstrument assembly further comprises an instrument configured for beingmated with the instrument driver. The instrument has an instrumentshaft, an end effector (e.g., an articulating tool), an instrument cableslidably disposed through the instrument shaft for actuating the endeffector, and an instrument coupling member (e.g., a hook) respectivelymounted to the instrument cable. The driver coupling member and theinstrument coupling member are configured for being interlockedtogether.

In one embodiment, the instrument driver has a plurality of drivercables slidably disposed through the driver shaft, and a plurality ofdriver coupling members respectively mounted to the driver cables. Inthis case, the instrument has a plurality of instrument cables slidablydisposed through the instrument shaft, and a plurality of instrumentcoupling members respectively mounted to the instrument cables, and thedriver coupling members and the instrument coupling members areconfigured for being respectively interlocked together. In anotherembodiment, the instrument driver has one of a post and a recess locatedon a distal surface of the driver shaft, and the instrument has anotherof the post and the recess on a proximal surface of the instrumentshaft, in which case, the post and recess are configured for being matedtogether to align the driver coupling member with the instrumentcoupling member.

In still another embodiment, the medical instrument assembly furthercomprises a storage chamber having a passage, in which case, theinstrument driver may be configured for being distally advanced withinthe passage to engage the instrument and for being proximally retractedwithin the passage to disengage the instrument. In this case, theinstrument coupling member may be configured for being biased radiallyoutward, and the passage may have a small diameter distal section and alarge diameter proximal section, such that the small diameter distalsection deflects the instrument coupling member radially inward toengage driver coupling member when the instrument driver is distallyadvanced within the passage, and the large diameter proximal sectionallows the instrument coupling member to deflect radially outward todisengage the driver coupling member when the instrument driver isproximally retracted within the passage.

In accordance with a second aspect of the present inventions, a roboticmedical system is provided. The robotic medical system comprises theinstrument driver, instrument, and storage chamber described above. Therobotic medical system further comprises a user interface configured forgenerating at least one command signal, and a drive unit (e.g., one thathas a motor array) coupled to the instrument driver. The robotic medicalsystem further comprises an electric controller configured, in responseto the at least one command signal, for directing the drive unit todistally advance the instrument driver within the passage of the storagechamber, such that the driver coupling member engages the instrumentcoupling member, and for directing the drive unit to proximally retractthe instrument driver within the passage of the storage chamber, suchthat the driver coupling member disengages the instrument couplingmember. In one embodiment, the user interface is located remotely fromthe drive unit, and the electrical controller is coupled to the driveunit via external cabling. In another embodiment, robotic medical systemfurther comprises a carriage on which the instrument driver is slidablydisposed. In another embodiment, the electric controller is configured,in response to the command signal(s), for directing the drive unit tolinearly translate the driver cable within the driver shaft to actuatethe end effector.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features of the present invention are described ingreater detail in the following detailed description, taken inconjunction with the accompanying drawings, in which:

FIG. 1 is a perspective view of one embodiment of a robotic surgicalsystem in which the interchangeable instrument principles of the presentinvention are applied;

FIG. 2 is a perspective view showing a portion of the system of FIG. 1,particularly the storage chamber and the driving mechanism;

FIG. 3 is a cross-sectional view illustrating the storage chamber, thedriver and the associated positioning of components, and as taken alongline 3-3 of FIG. 2;

FIG. 4 is a perspective view showing some further detail of theinstrument in this first embodiment;

FIG. 5 is a partial cross-sectional view showing further details of thedriver and instrument in this first embodiment;

FIG. 6 is a further cross-sectional view similar to that illustrated inFIG. 5 but showing the driver and instrument in an interlocked position;

FIG. 7 is a schematic cross-sectional perspective view that illustratesdetails of the instrument of the present invention;

FIGS. 8A and 8B are perspective views of the tool component of thesurgical instrument illustrating the cabling scheme;

FIG. 9 is a perspective view of an alternate embodiment of the presentinvention, providing linear registration rather than rotationalregistration;

FIG. 10 is a perspective view of another embodiment of a roboticsurgical system in which the interchangeable instrument principles ofthe present invention are applied;

FIG. 11 is a perspective view at the slave station of the system of FIG.10 illustrating the interchangeable instrument concepts;

FIG. 12 is a cross-sectional view through the storage chamber and astaken along line 12-12 of FIG. 11;

FIG. 13 is a longitudinal cross-sectional view, as taken along line13-13 of FIG. 11;

FIG. 14 is a perspective schematic view of the indexing mechanism usedin the embodiment illustrated in FIGS. 10-13;

FIG. 15 is a block diagram illustrating the steps taken to provideindexing for instrument interchange; and

FIG. 16 is a schematic diagram of another alternate embodiment of theinvention using a serial storage concept.

DETAILED DESCRIPTION

In this detailed description there is described an apparatus forenabling the interchange, at an operative site, between different typesof surgical instruments and in an automated fashion. In this way asubstitution of one instrument for another can be readily accomplished,without manually withdrawing one instrument followed by manual insertionof another instrument. Further, with this apparatus, and the associateduse of a guide tube, or the like, for receiving and guiding theinstrument, the interchange can be carried out quickly and safely, thusenabling medical procedures to be performed in a far shorter period oftime. The guide tube preferably extends to the operative site OS (seeFIG. 7) so that the instrument can transition safely thereto. Also, theguide tube preferably remains at the operative site even as theinstruments are exchanged in the guide tube, so as to avoid any tissueor organ damage during an instrument exchange. The operative site may bedefined as the general area in close proximity to where movement of thetool occurs in performing a surgical procedure, usually in the viewingarea of the endoscope and away from the incision.

In this description the instrument interchange principles areillustrated in association with two separate surgical systems, both ofwhich are robotic systems, sometimes also referred to as teleroboticsystems. However, the principles of this invention also apply to othersurgical instrumentation, such as used in minimally invasive surgery(MIS), where a number of instrument exchanges are typical in performinga medical or surgical procedure.

It is assumed, by way of example, that the systems disclosed herein arefor use in laparoscopic surgery. Thus, one system is disclosed in FIGS.1 through 8A and 8B, while a second system is disclosed in FIGS. 10-14.A variation of the first system is illustrated in FIG. 9. It is notedthat in FIG. 9, the instrument-to-driver registration is accomplishedwith a linear arrangement, while in the other versions described hereina rotating arrangement is employed, all to be described in furtherdetail later. Also, in the embodiments described herein the driver hasonly linear translation while the instrument storage chamber rotates(FIGS. 1 and 10) or slides (FIG. 9). In an alternate embodiment thedriver may rotate or otherwise move to different registration positions,as the instrument storage chamber remains stationary, as long as thereis relative motion between the instrument driver and instrument storagechamber.

Before reference is made to the detailed embodiments described herein,consideration is given to co-pending applications that are herebyincorporated by reference herein in their entirety, and that describe infurther detail aspects of the several components that make up theoverall robotic surgery system. In connection with descriptions setforth herein reference is made to the applications set forth in therelated application part of this application as well as to pending U.S.application Ser. No. 09/783,637 filed Feb. 14, 2001; U.S. applicationSer. No. 10/014,143 filed Nov. 11, 2001; as well as issued U.S. Pat. No.6,197,017.

The first embodiment of the invention is illustrated in FIGS. 1-8. FIG.1 shows a surgical instrument system 10 that performs surgicalprocedures. The system may be used to perform minimally invasiveprocedures. The system may also be used to perform open or endoscopicsurgical procedures. The system 10 includes a surgeon interface 11,computation system 12, and drive unit 13. The system controls theinstrument so as to position the end effector (tool) 18 of theinstrument 20 at the very distal end of and extending through the outletguide tube 24. During use, a surgeon may manipulate the handles 30 ofthe surgeon interface 11, to effect desired motion of the end effector18 within the patient, at the operative site which is schematicallyillustrated in FIG. 7. The movement of a handle 30 is interpreted by thecomputation system 12 to control the movement of the end effector (tool)18.

The system may also include an endoscope with a camera to remotely viewthe operative site. The camera may be mounted on the distal end of theinstrument, or may be positioned away from the site to provideadditional perspective on the surgical operation. In certain situations,it may be desirable to provide the endoscope through an opening otherthan the one used by the instrument.

The entire assembly illustrated in FIG. 1 is shown supported over thesurgical table 27, and in a position so that the guide tube 24 can beinserted through an incision in the patient and directed to theoperative site of the patient. The incision is represented in FIG. 1 bythe dashed line L. The surgical instrument system 10 of the presentinvention is preferably mounted on rigid post 19 which may be movablyaffixed to the surgical table 27, at bracket 28.

The surgical system 10 includes two mechanical cable-in-conduit bundles21 and 22. These cable bundles 21 and 22 terminate at one end at the twoconnection modules (couplers) 23A and 23B, which removably attach to thedrive unit 13. The drive unit 13 is preferably located outside thesterile field, although it may be draped with a sterile barrier so thatit may be operated within the sterile field. The other end of thebundles terminate at the surgical system 10. These terminations areshown in further detail in the description of the second embodiment thatis described later. Basically cables in the bundle 21 may control; theindexing for controlled rotation of the instrument storage chamber 40;rotation of the guide tube 24; as well as motion of the carriage 54 forcontrol of the linear translation of the driver 50. On the other handthe bundle 22 may control, for example, rotation of the instrumentwithin the guide tube 24, as well as actuation of the tool 18. Theinstrument storage chamber is also referred to herein as an instrumentretainer.

FIG. 1 also shows the instrument storage chamber 40 that is illustratedas supported over the base piece 51, which, in turn, is supported fromthe rigid post 19. The cable bundle 21 couples to the base piece 51 andcontrols motion of the instrument storage chamber 40, as well as thedriver 50. The guide tube 24 is supported at the outlet port side of theinstrument storage chamber 40, and is controlled for rotation relativeto the instrument storage chamber 40. Rotation of the guide tube 24provides a corresponding rotation of the instrument and tool. Theinstrument storage chamber 40 has at its inlet side a port for receivingthe driver 50, and for permitting engagement of the driver with the oneof the instruments in the instrument storage chamber 40 that is inregistration with the driver 50. The driver 50 is supported from thecarriage 54 which transitions on rails 55, and is controlled from cablebundle 22. The driver may also be referred to herein as an instrumenttransporter.

In accordance with the setup of the system of FIG. 1, the guide tube 24of the surgical instrument system 10 is inserted into the patientusually through an incision. Usually, a cannula is positioned in theincision, is maintained in position and receives the guide tube 24. Thisincision is illustrated in FIG. 1 by the dashed line L. The system isthen mounted to the rigid post 19. The cable bundles 21 and 22 are thencoupled to the drive unit 13. The connection modules or couplers 23A and23B at the end of respective cable bundles 21 and 22 are then engagedinto the drive unit 13. The system is then ready for use and controlfrom the master station side at surgeon interface 11. For furtherdetails of the entire slave side of the system, including the driveunit, detachability at the drive unit, the cabling and cable couplers,refer to U.S. Ser. Nos. 09/783,637; and 10/014,143, previouslymentioned.

Now, reference is made, not only to FIG. 1 but also to FIGS. 2 through 6that illustrate further details depicting the interchangeable instrumentconcepts of the present invention. FIG. 7 illustrates schematically acabling scheme that may be used in the instrument. FIG. 9 illustrates analternative to the revolving chamber construction, in the form of alinearly translatable housing or chamber arrangement.

The revolving instrument storage chamber 40 includes a base 42, oppositeend walls 43 and a cylindrical chamber or magazine 44. In the embodimentillustrated herein, chamber 44 has six elongated passages 46 each forreceiving an instrument. The chamber 44 is supported by a centrallydisposed support rod 47, such as illustrated in FIG. 5. The support rod47 may be supported in bearings (not shown) at the opposite end walls43. The instrument storage chamber 40 has its rotation controlled atbase piece 51 (see FIG. 1) so that when an operator at interface 11wants to change instruments, a command can be sent from the master tothe slave side to rotate the magazine 44 so that a different instrumentis in alignment with the driver 50. Of course, this exchange only occurswhen the driver has been withdrawn to its rest (disengaged) position.Specific sequences of the interchange action are described later. Thecommand that is sent may be initiated by any one of several means, someof which are described in some detail later.

FIGS. 2 and 3 also illustrate the outlet guide tube 24. The tube 24 issecured to one of the end walls 43 and is essentially fixed in axialposition relative to that end wall 43 of the rotating instrument storagechamber 40, but is capable of rotation on its own axis, and relative tothe chamber 40. Details of this rotational support are described furtherin connection with the second embodiment described in FIGS. 10-14. Theend walls 43 supporting the magazine 44 are fixed to the base 42, whichis supported over the base piece 51 which, in turn, is fixed to therigid post 19. Thus, in this particular embodiment the instrumentstorage chamber 40 rotates but does not have any significant linearmovement toward or away from the operative site. Thus, in this firstembodiment the instrument control has a somewhat limited number ofdegrees-of-freedom. The degrees-of-freedom can be increased by providingthe guide tube with a curved distal end, like that illustrated in thesecond embodiment of the invention in FIGS. 10-14.

FIGS. 1 through 6 also illustrates the instrument driver 50. Theinstrument driver 50 is adapted to enter an end inlet port 49 in thewall 43 of the rotating chamber 40. In this regard, refer to FIG. 3 forthe inlet port 49. Also, as discussed previously in connection with FIG.1, in the base piece 51 there is an indexing mechanism that controls therotation of the rotating storage chamber 44 so that different ones ofthe passages 46 are adapted to be aligned with the input driver port 49.This registration control may be carried out using a detent mechanism sothat the proper instrument is aligned and selected from the chamber bythe instrument driver 50. Refer to FIG. 2 and the cable bundle 21 thatinterconnects with the chamber 44 for selective and registered rotationthereof. Also, refer to FIG. 14 for an example of an indexing mechanism.

In a similar manner, at the opposite end wall 43 of the chamber 40,there is provided an outlet port 48, such as illustrated in FIG. 3, andthat aligns with the outlet guide tube 24. Also, in FIGS. 2 and 3 thereis illustrated the carriage 54 that carries the instrument driver 50 andthat transitions along the support rails 55 to enable the driver toselectively engage with and drive the instrument forward through theguide tube 24 and toward the operative site.

FIG. 3 illustrates a cross-sectional view of one embodiment of theinterchangeable instrument apparatus of the present invention. Aninstrument 20 with its end effector (tool) 18 is illustrated disposed inone of the elongated chambers 46 of the rotating chamber 44. Inpractice, each of the other passages 46 can contain other types ofinstruments, with a variety of different tool or end effectors. For thesake of clarity, only one of the instruments is illustrated in FIG. 3,it being understood that up to six other instruments of different typesmay be disposed in other ones of the elongated passages 46. Also, themagazine 44 may be constructed with fewer or more instrument-receivingpassages. FIG. 3 also illustrates the driver 50 in a position where theend 56 thereof is positioned just entering the inlet port 49 with theend 56 about to engage the end 25 of the instrument 20. The position ofthe instrument driver 50 is considered as a “rest position” when the end57 is disposed in wall 43, but has not yet entered the magazine 44 sothat the magazine 44 is free to rotate. To interlock and align thedriver and the instrument, there is provided a post 58 (see FIG. 5) onthe driver 50 and an accommodating recess 26 (see FIG. 5) in theinstrument end 25.

As mentioned previously, there are mechanical cables extending inbundles 21 and 22 illustrated in FIG. 1. The cables in bundle 22, inparticular, couple by way of pulleys and then extend the length of thedriver 50 to the instrument 20. The cabling and control pulleyarrangements are disclosed in further detail in the second embodiment asshown in FIGS. 10-14. This cabling is for operating the end effector 18illustrated in FIG. 1. To provide continuity of this mechanical controlcabling, both the instrument driver as well as the instrument carryinterconnecting cable connections. These are illustrated clearly inFIGS. 4 through 6. Also refer to the schematic perspective view of FIG.7 showing the manner in which the cables couple about pulleys 29 andextend through the driver to intercouple with cabling of the instrument20. These cable connections between the driver and instrument may alsobe considered as defining a coupling section or coupling interface 59where the driver and instrument are releasably engageable. One may alsoconsider the driver and instrument, such as illustrated in FIGS. 1-6, ascollectively being an instrument member including a work section(instrument 20 and tool 18), and a driver section (driver 50).

The instrument driver 50 has passages 61 (see FIG. 4) for receiving acable 62 (see FIGS. 4, 5 and 6). As illustrated in FIGS. 4, 5 and 6 theend of cable 62 terminates in a hook 64. The hook 64 is adapted toengage with a similar-configuration hook 66 at the end of cable 68 asillustrated in FIG. 6. FIG. 4 illustrates a series of slots or passages61, which in the illustrated embodiment comprise six such slots 61. Eachof these slots receives a cable 62 with its end hook 64.

Referring further to FIG. 4, this illustrates the end 25 of theinstrument 20. Also illustrated are the elongated slots 61 in the driver(transporter) 50. FIG. 4 illustrates the cables 68 and their associatedhooks 66 associated with the instrument 20. Also shown is the cable 62with its hook 64 disposed in slot 61.

FIG. 5 illustrates the end 56 of the instrument driver 50 as the driver50 is transitioning through the port 49 for engagement with theinstrument 20. The driver 50 has not yet engaged the instrument 20, buthas just left its rest position. The “rest” (disengaged) position forthe instrument driver 50 is one in which the end 56 of the driver 50 isdisposed in the end wall 43 and out of the passage 46 so that thechamber 44 is free to rotate. In the position of FIG. 5, the hook 66associated with the instrument 20 is preferably biased to a somewhatoutward deflected position. In this regard, it is noted that the passage46 has an enlarged section 46A that permits the hook 66 to deflectoutwardly, as illustrated. The hooks are essentially spring biasedoutwardly so as to contact the inner wall surface of enlarged section46A. This enables the driver to pass by the hooks 66 for engagement withthe instrument 20.

As the driver 50 proceeds from the position illustrated in FIG. 5,toward the position illustrated in FIG. 6, the hook 64 passes under thehook 66 and as the driver is driven further to the left, as viewed inFIG. 3, the hooks 64 and 66 become interlocked in the positionillustrated in FIG. 6 and there is thus cable continuity from cable 62to cable 68. As is discussed in further detail hereinafter, theoperation of these cables provide operation of certain actions of theend effector 18. As the driver end 56 engages the instrument end 25, thepost 58 engages with the recess 26 so as to properly align the driverand instrument. At the initial point of contact the hooks 66 are stillout of engagement with the hooks 64. However, as the driver movesfurther to the left the instrument starts to transition out of thestorage chamber passage 46, and the hooks 66 transition into the smallerdiameter section of the passage 46, causing them to deflect intoengagement with the hooks 64, such as illustrated in FIG. 6. Thecoupling interface 59 formed essentially between the hooks 64 and 66 ismaintained as the instrument transitions out of the instrument storagechamber 40. Refer to FIG. 7.

The driver 50 is of a sufficient length so that the selected instrument20 is driven out of the chamber 44 and into the outlet guide tube 24.The instrument is then transitioned through the guide tube 24 to theposition illustrated in FIG. 1 where the end effector or tool 18 of theinstrument extends from the distal end of the guide tube 24 at aposition inside the body cavity (operative site). All the while that theinstrument is being transitioned to the end of the guide tube 24, theinterconnecting cables are maintained in an interlocked position such asillustrated by the engaged hooks 64 and 66 in FIG. 6.

When it is desired to change to a different instrument, the driver 50 iswithdrawn or in other words is moved in a direction to the right in FIG.3. This carries the instrument with the instrument driver to the rightand when the instrument reaches a position approximately as illustratedin FIG. 5, because of the increased diameter of the section 46Aillustrated in FIG. 5, the hooks 66 are biased outwardly and disengagefrom the hooks 64. This essentially disengages the driver from theinstrument and the driver is then in a position to be withdrawn throughthe port 49, no longer engaging with the instrument. This also leavesthe instrument 20 in place in the instrument storage chamber 44 inreadiness for a subsequent usage.

With the driver disengaged from the instrument, the instrument storagechamber can then be rotated to align a different instrument with thedriver. The cabling in bundle 21, via base piece 51, controls theposition of chamber 40 so as to select a different instrument byrotating the chamber 44 so that a different instrument registers withthe driver 50. For an example of a registration mechanism refer to FIG.14. A different instrument would also carry cabling similar to thatillustrated in FIG. 5. Once the new instrument is in-line with theinstrument driver 50 then the driver 50 may be engaged once again topass through the port 49 engaging the new instrument and thustransitioning the new instrument out the outlet guide tube 24 to aposition where the tool of the instrument is at the operative site inreadiness for use and control from the master station surgeon interface.

A wide variety of different instruments may be supported in theinstrument storage chamber 40. Tool 18 may include a variety ofarticulated tools, such as jaws, scissors, graspers, needle holders,micro dissectors, staple appliers, tackers, suction irrigation tools,clip appliers, that have end effectors driven by wire links, eccentriccams, push-rods or other mechanisms. In addition, tool 18 may comprise anon-articulated instrument, such as cutting blades, probes, irrigators,catheters or suction orifices. Alternatively, tool 18 may comprise anelectrosurgical probe for ablating, resecting, cutting or coagulatingtissue.

To provide proper alignment of the instrument 20 in the chamber 40 andwith the driver 50 there are preferably provided interlocking surfacessuch as a tongue and groove (not shown) between the walls of the chamberpassage and the outer surface off the instrument and/or driver.Interlocking or guiding surfaces may also be provided within the guidetube 24. Thus, as the different instruments are moved in and out of therotating chamber they will always be properly aligned with the driver sothat the proper cabling is provided to control the instrument.

Reference is now made to FIG. 7 for a schematic illustration of thecabling as it extends from the bundle 22, through the driver 50, to theinstrument 20, and the tool 18. The cabling extends about pulleys 29 andinto the slots 61 in the instrument driver 50. FIG. 7 illustrates thedriver 50 in a position in which it has entered the guide tube 24 andtransitions to a location essentially at the end of the guide tube wherethe tool 18 is located and at the operative site OS. At the end of thedriver where the cable hooks engage, such as illustrated in FIGS. 5 and6, there is the coupling or interface section 59. FIG. 7 alsoillustrates the passages 46 and another non-selected tool within theinstrument storage chamber.

The construction of one form of tool is illustrated in FIGS. 8A and 8B.This is in the form of a set of jaws or grippers. This tool is shown forthe purpose of illustration, it being understood that a variety of othertool may be used. FIG. 8A is a perspective view showing the tool pivotedat the wrist while FIG. 8B is an exploded view of the tool. The tool 18is comprised of four members including the base 600, link 601, uppergrip or jaw 602 and lower grip or jaw 603. The base 600 is affixed tothe flexible stem section 302. This flexible section may be constructedof a ribbed plastic. This flexible section may be used when a curved endguide tube (see FIG. 11) is used so that the instrument will readilybend through the curved actuator tube 24.

The link 601 is rotatably connected to the base 600 about axis 604. FIG.8B illustrates a pivot pin at 620. The upper and lower jaws 602 and 603are rotatably connected to the link about axis 605, where axis 605 isessentially perpendicular to axis 604. FIG. 8B illustrates another pivotpin at 624.

Six cables 606-611, shown schematically in FIG. 8A and FIG. 8B, actuatethe four members 600-603 of the tool. Cable 606 travels through theinsert stem (section 302) and through a hole in the base 600, wrapsaround curved surface 626 on link 601, and then attaches on link 601 at630. Tension on cable 606 rotates the link 601, and attached upper andlower grips 602 and 603, about axis 604 (wrist pivot). Cable 607provides the opposing action to cable 606, and goes through the samerouting pathway, but on the opposite sides of the insert. Cable 607 mayalso attach to link 601 generally at 630. Cables 606 and 607 may be onecontinuous cable secured at 630.

Cables 608 and 610 also travel through the stem 302 and though holes inthe base 600. The cables 608 and 610 then pass between two fixed posts612. These posts constrain the cables to pass substantially through theaxis 604, which defines rotation of the link 601. This constructionessentially allows free rotation of the link 601 with minimal lengthchanges in cables 608-611. In other words, the cables 608-611, whichactuate the grips 602 and 623, are essentially decoupled from the motionof link 601. Cables 608 and 610 pass over rounded sections and terminateon grips 602 and 603, respectively. Tension on cables 608 and 610 rotategrips 602 and 603 counter-clockwise about axis 605. Finally, as shown inFIG. 8B, the cables 609 and 611 pass through the same routing pathway ascables 608 and 610, but on the opposite side of the instrument. Thesecables 609 and 611 provide the clockwise motion to grips or jaws 602 and603, respectively. At the jaws 602 and 603, as depicted in FIG. 8B, theends of cables 608-611 may be secured at 635. This securing may occurwith the use of an adhesive such as an epoxy glue or the cables could becrimped to the jaw.

Reference is now made to FIG. 9. FIG. 9 schematically illustrated analternate embodiment of the present invention. In FIGS. 1-8 thedifferent instruments are selected by means of a rotating arrangement.In FIG. 9 the selection is made on an essentially linear basis. Thus,instead of the rotating member illustrated in FIGS. 1-8, there is a flatarray 70 also having a series of elongated passages 72 extendingtherethrough. Each of these passages accommodates an instrument. FIG. 9also schematically illustrates, by the same reference characters, theinstrument driver 50 and the outlet guide tube 24 such as previouslyillustrated in FIGS. 1-8. The flat array 70 may be driven selectively inthe direction of arrow 74 so as to align different ones of the passages72 with the driver 50 and guide tube 24. Mechanisms for selective lineardrive are well known, as are mechanisms for registration so as toprovide proper alignment between the instrument and instrument driver.

In connection with the aforementioned description of the cables/hooks,it is noted that the interchange system is designed preferably to haveall cabling maintained in tension. In this way, as an instrument isengaged, all of the cabling running therethrough is in tension andproperly operative to control the end effector whether it be a set ofjaws as illustrated in FIGS. 8A and 8B or some other type of instrument.If an end effector has less degrees of movement than that illustrated inFIGS. 8A and 8B this is still effectively controlled, but with the useof fewer cable control signals (fewer cables will actually beactivated).

Reference is now made to the second robotic surgical system depicted inFIGS. 10-14, and that discloses a system having a greater number ofdegrees-of-freedom than the system described in FIGS. 1-8. In FIGS.10-14 the same reference characters are used for similar components asdepicted in FIGS. 1-8.

The surgical robotic system, as illustrated in FIGS. 10-14, althoughpreferably used to perform minimally invasive surgery, may also be usedto perform other procedures as well, such as open or endoscopic surgicalprocedures. FIG. 10 illustrates a surgical instrument system 10 thatincludes a master station M at which a surgeon 2 manipulates an inputdevice, and a slave station S at which is disposed a surgicalinstrument. In FIG. 1 the input device is illustrated at 3 beingmanipulated by the hand or hands of the surgeon. The surgeon isillustrated as seated in a comfortable chair 4. The forearms of thesurgeon are typically resting upon armrests 5.

FIG. 10 illustrates a master assembly 7 associated with the masterstation M and a slave assembly 8 associated with the slave station S.Assembly 8 may also be referred to as a drive unit. Assemblies 7 and 8are interconnected by means of cabling 6 with a controller 9. Asillustrated in FIG. 10, controller 9 typically has associated therewithone or more displays and a keyboard. Reference is also made to, forexample, the aforementioned U.S. Ser. No. 10/014,143, for furtherdetailed descriptions of the robotic controller operation and associatedalgorithm.

As noted in FIG. 10, the drive unit 8 is remote from the operative siteand is preferably positioned a distance away from the sterile field. Thedrive unit 8 is controlled by a computer system, part of the controller9. The master station M may also be referred to as a user interfacevis-vis the controller 9. Commands issued at the user interface aretranslated by the computer into an electronically driven motion in thedrive unit 8. The surgical instrument, which is tethered to the driveunit through the cabling connections, produces the desired replicatedmotion. FIG. 10, of course, also illustrates an operating table T uponwhich the patient P is placed.

Thus, the controller couples between the master station M and the slavestation S and is operated in accordance with a computer algorithm. Thecontroller receives a command from the input device 3 and controls themovement of the surgical instrument so as to replicate the inputmanipulation.

With further reference to FIG. 10, associated with the patient P is thesurgical instrument 14, which in the illustrated embodiment actuallycomprises two separate instruments one on either side of an endoscope E.The endoscope includes a camera to remotely view the operative site. Thecamera may be mounted on the distal end of the instrument insert, or maybe positioned away from the site to provide additional perspective onthe surgical operation. In certain situations, it may be desirable toprovide the endoscope through an opening other than the one used by thesurgical instrument 14. In this regard, in FIG. 10 three separateincisions are shown, two for accommodating the surgical instruments anda centrally disposed incision that accommodates the viewing endoscope. Adrape is also shown with a single opening.

The surgical instrument 14 is generally comprised of two basiccomponents including a surgical adaptor or guide 15 and an instrument14. FIG. 10 illustrates the surgical adaptor 15, which is comprisedprimarily of the guide tube 24. In FIG. 10 the instrument 14 is notclearly illustrated but extends through the guide tube 24. Theinstrument 14 carries at its distal end the tool 18. Descriptions of thesurgical instrument are found hereinafter in additional drawings,particularly FIG. 11. The surgical adaptor 15 is basically a passivemechanical device, driven by the attached cable array.

In FIG. 10 there is illustrated cabling 22 coupling from the instrument14 to the drive unit 18. The cabling 22 is preferably detachable fromthe drive unit 8. Furthermore, the surgical adaptor 15 may be ofrelatively simple construction. It may thus be designed for particularsurgical applications such as abdominal, cardiac, spinal, arthroscopic,sinus, neural, etc. As indicated previously, the instrument 14 couplesto the adaptor 15 and essentially provides a means for exchanging theinstrument tools. The tools may include, for example, forceps, scissors,needle drivers, electrocautery etc.

Referring still to FIG. 10, the surgical system 10 may preferably beused to perform minimally invasive procedures, although it is to beunderstood that the system may also be used to perform other procedures,such as open or endoscopic surgical procedures. The system 10 includes asurgeon's interface 11, computation system or controller 9, drive unit 8and the surgical instrument 14. The surgical system 10, as mentionedpreviously, is comprised of an adaptor or guide 15 and the instrument14. The system is used by positioning a tool 18 of the instrument, whichis inserted through the surgical adaptor or guide 15. During use, asurgeon may manipulate the input device 3 at the surgeon's interface 11,to effect desired motion of the tool 18 within the patient. The movementof the handle or hand assembly at input device 3 is interpreted by thecontroller 9 to control the movement of the guide tube 24, instrument,and tool 18.

The surgical instrument 14, along with the guide tube 24 is mounted on arigid post 19 which is illustrated in FIG. 10 as removably affixed tothe surgical table T. This mounting arrangement permits the instrumentto remain fixed relative to the patient even if the table isrepositioned. Although, in FIG. 10 there are illustrated two suchinstruments, even a single surgical instrument may be used.

As indicated previously, connecting between the surgical instrument 14and the drive unit 8, are cablings. These include two mechanicalcable-in-conduit bundles 21 and 22. These cable bundles 21 and 22 mayterminate at two connection modules, not illustrated in FIG. 10 (seeFIG. 1), which removably attach to the drive unit 8. Although two cablebundles are described here, it is to be understood that more or fewercable bundles may be used. Also, the drive unit 8 is preferably locatedoutside the sterile field, although it may be draped with a sterilebarrier so that it may be operated within the sterile field.

In the preferred technique for setting up the system, and with referenceto FIG. 10, the surgical instrument 14 is inserted into the patientthrough an incision or opening. The instrument 14 is then mounted to therigid post 19 using a mounting bracket 31. The cable bundles 21 and 22are then passed away from the operative area to the drive unit 8. Theconnection modules of the cable bundles are then engaged into the driveunit 8. The separate instrument members of instrument 14 are thenselectively passed through the guide tube 24. This action is inaccordance with the interchangeable instrument concepts of thisinvention.

The instrument 14 is controlled by the input device 3, which is bemanipulated by the surgeon. Movement of the hand assembly producesproportional movement of the instrument 14 through the coordinatingaction of the controller 9. It is typical for the movement of a singlehand control to control movement of a single instrument. However, FIG.10 shows a second input device that is used to control an additionalinstrument. Accordingly, in FIG. 10 two input devices are illustratedand two corresponding instruments. These input devices are usually forleft and right hand control by the surgeon.

The surgeon's interface 11 is in electrical communication with thecontroller 9. This electrical control is primarily by way of the cabling6 illustrated in FIG. 10 coupling from the bottom of the master assembly7. Cabling 6 also couples from the controller 9 to the actuation ordrive unit 8. This cabling 6 is electrical cabling. The actuation ordrive unit 8, however, is in mechanical communication with theinstrument 14. The mechanical communication with the instrument allowsthe electromechanical components to be removed from the operativeregion, and preferably from the sterile field. The surgical instrument14 provides a number of independent motions, or degrees-of-freedom, tothe tool 18. These degrees-of-freedom are provided by both the guidetube 24 and the instrument 14.

FIG. 10 shows primarily the overall surgical system. FIGS. 11-14 showfurther details particularly of the interchangeable instrument conceptsas applied to this system. FIG. 15 illustrates a control algorithm forthe system. The system of FIG. 10 is adapted to provide sevendegrees-of-freedom at the tool 18. Three of the degrees-of-freedom areprovided by motions of the adaptor 15, while four degrees-of-freedom maybe provided by motions of the instrument 14. As will be described indetail later, the adaptor is remotely controllable so that it pivots,translates linearly, and has its guide tube rotate. The instrument alsorotates (through the instrument driver), pivots at its wrist, and hastwo jaw motions at the tool.

Now, reference is made to the more detailed drawings of FIGS. 11-14.FIG. 11 is a perspective view at the slave station of the system of FIG.10 illustrating the interchangeable instrument concepts. FIG. 12 is across-sectional view through the storage chamber and as taken along line12-12 of FIG. 11. FIG. 13 is a longitudinal cross-sectional view, astaken along line 13-13 of FIG. 11. FIG. 14 is a perspective schematicview of the indexing and registration mechanism used in the embodimentillustrated in FIGS. 10-13.

Reference is now made to FIG. 11 which is a perspective viewillustrating the instrument 14 and the adaptor 15 at the slave stationS. This instrument system is secured in the manner illustrated in FIG.10 to the rigid post 19 that supports the surgical instrument by way ofthe mounting bracket 31 illustrated in FIG. 10, but not shown in FIG.11. FIG. 11 also shows several cables that may be separated into fivesets for controlling different motions and actions at the slave station.These are individual cables of the aforementioned bundles 21 and 22referred to in FIG. 10. FIG. 11 also illustrates the support yoke 220that is secured to the mounting bracket 31, the pivot piece 222, andsupport rails 224 for the carriage 226. The rails are supported in endpieces 241 and 262 with the end piece 241 attached to the pivot piece222. The pivot piece 222 pivots relative to the support yoke 220 aboutpivot pin 225. A base piece 234 is supported under the carriage 226 bymeans of the support post 228. The support post 228 in essence supportsthe entire instrument assembly, including the adaptor 15 and theinstrument 14.

As indicated previously, the support yoke 220 is supported in a fixedposition from the mounting bracket 31. The support yoke 220 may beconsidered as having an upper leg 236 and a lower leg 238. In theopening 239 between these legs 236 and 238 is arranged the pivot piece222. Cabling extends into the support yoke 220. This is illustrated inFIG. 11 by the cable set 501. Associated with the pivot piece 222 andthe carriage 226 are pulleys (not shown) that receive the cabling forcontrol of two degrees-of-freedom. This control from the cable set 501includes pivoting of the entire instrument assembly about the pivot pin225. This action pivots the guide tube 24 essentially in a single plane.This pivoting is preferably about an incision of the patient which isplaced directly under, and in line with, the pivot pin 225. Other cablesof set 501 control the carriage 226 in a linear path in the direction ofthe arrow 227. See also the cables 229 extending between the carriage226 and the end pieces 241 and 262. The carriage moves the instrumentand guide tube 24 back and forth in the direction of the operative siteOS. Incidentally, in FIG. 11 the instrument is in its fully advancedstate with the tool at the operative site OS.

The base piece 234 is the main support for the interchangeableinstrument apparatus of the invention. Refer to FIGS. 11-14. The basepiece 234 supports the guide tube 24, the instrument storage chamber540, and the instrument driver 550. The instrument driver 550 issupported from another carriage, depicted in FIGS. 11 and 13 as thecarriage 552, and that, in turn, is supported for translation on thecarriage rails 554. The rails 554 are supported at opposite ends at endpieces 556 and 558, in a manner similar to the support for the othercarriage 226. A support post 560 interconnects the carriage 552 with theinstrument driver housing 570.

With further reference to FIG. 11, and as mentioned previously, thereare a number of cable sets from bundles 21 and 22 coupled to and forcontrolling certain actions of the instrument system. Mention has beenmade of the cable set 501 for controlling instrument pivoting andtranslation, as previously explained. In addition, FIG. 11 depicts fourother cable sets 503, 505, 507, and 509. Cable set 503 controls rotationof the guide tube 24. Cable set 505 controls the carriage 552, and, inturn, the extending and retracting of the instrument driver forinstrument exchange. Cable set 507 controls rotation of the instrumentthrough rotation of the instrument driver. Finally, cable set 509controls the tool via the instrument driver and instrument. There isalso one other set of control cables not specifically illustrated inFIG. 11 that controls the indexing motor 565, to be discussed in furtherdetail later.

FIG. 13 shows a cross-sectional view through the interchangeableinstrument portion of the overall instrument system. This clearlyillustrates the internal cable and pulley arrangement for the variousmotion controls. There is a pulley 301 driven from the cable set 503that controls rotation of the guide tube 24. There is also a pulley 303driven from cable set 505, along with a companion pulley 305 thatprovides control for the carriage 552. FIG. 13 also illustrates anotherpulley 307 driven from cable set 507, and for controlling the rotationof the instrument driver 550, and, in turn, the selected instrument.

FIG. 13 illustrates the guide tube 24 supported from the base piece 234.The guide tube 24 is hollow and is adapted to receive the individualinstruments or work sections 541 disposed in the instrument storagechamber 540, as well as the instrument driver 550. Refer to FIG. 7 foran illustration of the instrument and instrument driver positioned inthe guide tube 24. FIG. 13 shows the instrument driver 550 in its restor disengaged position. The proximal end 24A of the guide tube 24 issupported in the base piece 234 by means of a pair of bearings 235 sothat the guide tube 24 is free to rotate in the base piece 234. Thisrotation is controlled from the pulley 237 which is secured to the outersurface of the guide tube 24 by means of a set screw 231. The pulley 237is controlled to rotate by means of the cabling 310 that intercouplesthe pulleys 301 and 237 and that is an extension of the cabling 503.Thus, by means of the cable and pulley arrangement, and by means of therotational support of the guide tube 24, the rotational position of theguide tube 24 is controlled from cable set 503. Of course, thiscontrolled rotation is effected from the master station via thecontroller 9, as depicted in the system view of FIG. 10, and as afunction of the movements made by the surgeon at the user interface 11.

As indicated before the proximal end 24A of the guide tube 24 issupported from the base piece 234. The distal end of the guide tube 24,which is adapted to extend through the patient incision, and is disposedat the operative site OS illustrated about the tool 18 in FIG. 11, andwhere a medical or surgical procedure is to be performed. In the systemshown in FIG. 11 the distal end of the guide tube 24 is curved at 24B.In this way by rotating the guide tube 24 about its longitudinal axisthere is provided a further degree-of-freedom so as to place the endtool at any position in three-dimensional space. The rotation of theguide tube 24 enables an orbiting of the end tool about the axis of theguide tube 24. The guide tube 24 is preferably rigid and constructed ofa metal such as aluminum. The tool 18 illustrated in FIG. 11 may be thesame tool as illustrated in FIGS. 8A and 8B. Also, when the instrumentis fully engaged, as in FIG. 11, the cabling and cable interface is asillustrated in FIG. 7.

FIG. 13 also illustrates a cross-section of the instrument storagechamber 540 including the storage magazine 549, and showing two of thesix instrument passages 542 in the storage magazine 549. The instrumentstorage chamber may also be referred to herein as an instrumentretainer. In FIG. 13 one of the instruments 541 is about to be engagedby the instrument driver 550. The other instrument 541 is in place(storage or rest position) in the instrument storage chamber 540, andout of the path of the instrument driver 550. One of the instruments 541carries a gripper tool illustrated at 543, while the other instrumentcarries a scissors 544. Because these instruments are adapted to pass tothe guide tube 24 and be positioned at the distal end 24B thereof, thebody 548 of the instrument is flexible so as to be able to curve withthe curvature of the guide tube 24.

Although reference is made herein to the separate instrument andinstrument driver, such as illustrated in FIG. 13, once they are engagedthey function as a single piece instrument member. Accordingly referenceis also made herein to the instrument driver 550 as a “driver section”of the overall one piece instrument member, and the instrument 541 as a“working” section of the instrument member. The instrument member hasalso been previously discussed as having a “coupling section” or“interface section”, which is defined between the working section andthe driver section where the cables interlock by means of the engaginghook arrangement, such as clearly depicted in FIGS. 5 and 6. This isshown in FIG. 13 at 559. This is analogous to the interface 59illustrated in FIG. 7.

The carriage 552 illustrated in FIG. 13 is moved linearly by the cables555 that extend between pulleys 303 and 305. These cables attach to thecarriage 552. The carriage movement is controlled from cable set 505. Itis the movement of the carriage 552 that drives the instrument driver(driver section) 550. The instrument driver 550, in its rest ordisengaged position, is supported between the instrument driver housing570 and the wall 562 that is used for support of the instrument storagechamber 540. The instrument magazine 549 is rotationally supported bymeans of the axle or shaft 547, with the use of bushings or bearings,not shown. This support is between walls 562 and 563.

FIG. 13 shows the very distal end 525 of the instrument driver(transporter) 550 supported at wall 562. In the rest position of theinstrument driver 550 the driver is out of engagement with theinstruments and the magazine 549, thus permitting rotation of theinstrument storage chamber 540. The proximal end 526 of the instrumentdriver 550 is supported at the instrument driver housing 570. It may berotationally supported by means of a bushing 527. The instrument driver550 is supported for rotation, but rotation is only enabled once thedriver has engaged the instrument and preferably is at the operativesite. The rotation of the instrument driver 550 is controlled from cableset 503 by way of the pulley 307.

In FIG. 11 the cable set 509 is illustrated as controlling theinstrument motions including tool actuation. These cables control aseries of pulleys shown in FIG. 13 as pulleys 529. As indicted in FIG.13 these pulleys control cabling that extends through the instrumentdriver and the instrument for control of instrument and tool motions.The cables that are controlled from these pulleys may control threedegrees-of-freedom of the instrument, including pivoting at the wristand two for gripper action. For the details of the interlocking of theinstrument and instrument driver refer to FIGS. 5 and 6. The sameengagement arrangement can be used in this second embodiment of theinvention including the mating hook arrangement, interlocked atinterface 559 when the instrument driver and instrument are engaged.

Reference has been made before to the indexing motor 565. This motor isillustrated in FIG. 11 positioned next to the base piece 234, and isfurther illustrated in FIG. 14 located for interaction with theinstrument storage chamber 540. The indexing motor 565 is controlledfrom the master station side, and accordingly there is another cable set(not shown) that actuates the indexing motor 565. The indexing motor 565may be a stepper motor having a degree of rotation that corresponds tothe desired rotation of the instrument storage chamber 540. The steppermotor may be designed to provide 60 degrees of rotation for eachactuation, corresponding to an instrument storage chamber 540 having sixpassages (360 degrees divided by 6) for receiving instruments.

In FIG. 14 the stepper motor 565 has an output shaft 566 that supportsan indexing disk 567, shown also in dashed line in FIG. 12. The indexingdisk 567 is fixed to the shaft 566 and so rotates with the shaft 566.FIG. 12 illustrates the disk 567 carrying four pins 568 disposed at theperiphery of the disk 567. FIG. 14 also shows these pins 568. The pins568 selectively engage in indexing slots 569 in an end wall of themagazine 549. To insure that the rotating chamber stays in properregistration with the instrument driver a spring and ball detentarrangement is employed. Refer to FIGS. 11-14 illustrating a standardball and spring member 575 supported in the wall 563. The ball of member575 is urged against an end wall surface 576 of the magazine 549. Thisend wall has a series of detent dimples 577 (see FIG. 14) disposed atlocations corresponding to the passages in the magazine 549. The steppermotor 565 is selectively operated under surgeon control from the masterstation. Each step rotates the disk 567 through 90 degrees. Theengagement of the pins 568 with the slots 569 causes a correspondingrotation of the magazine 549 through 60 degrees. Each subsequentrotation of the stepper motor 565 causes a further 60 degree rotation ofthe magazine 549. The stepper motor 565 is controllable in a manner sothat, with proper decoding, there may be multiple step actuations to getfrom one instrument to the next selected instrument.

The operation of the slave instrument is in a robotic manner from themaster station, such as illustrated in FIG. 10. The surgeon can controlseveral degrees-of-freedom of the instrument system. In addition, whenthe surgeon wishes to exchange instruments this can be done directlyfrom the master station from an actuation member and at the proper timein the surgical procedure. One type of actuation member may be by meansof a foot switch 410 illustrated in FIG. 10 within access of thesurgeon. The foot switch 410 couples to the controller 9. Appropriateelectrical signals are coupled from the master station to the slavestation basically to control the stepper motor 565 for indexing themagazine 549.

The sequence of operation for the indexing is demonstrated in the flowchart of FIG. 15. This block diagram indicates the sequence of stepsperformed commencing with a rest position of the system in which theinstruments are all in place in the storage chamber 540, and theinstrument driver is in the position substantially as illustrated inFIG. 13, just out of contact with the registered instrument and with thedriver end 525 disposed in the wall 562. It is this position that isillustrated in FIG. 15 by box 420. The next step is to check theregistration of the instrument driver with the instrument itself. Thisis depicted by the box 422. This step may involve the use of some knownregistration system, such as one using an optical sensing arrangement todetermine proper registration between the instrument driver 550 and eachof the passages in the magazine 549, along with the instrument 541. Ifproper registration is detected then the system proceeds to the nextstep indicated in FIG. 15 by box 426, which activates the instrumentdriver 550. This starts the process of driving the instrument to theoperative site OS. This involves mechanical control signals on the cableset 505 controlling the carriage 552, and in turn, the instrument driver550. If an improper registration is detected then box 424 indicates thestep of correcting the registration. This may be carried out in a wellknown manner with the use of an optical system to provide slightrotation to the instrument storage chamber 540 so as to obtain properregistration. This system may also use some type of a feedback system.

The next step in the system is indicated in FIG. 15 by the box 428 whichsimply detects the fully engaged position of the instrument driver andinstrument. This is the position illustrated in FIG. 11. Again, thisposition can be readily detected by optical means. The next stepillustrated in FIG. 15 by box 430 is one that commences the interchangeprocess. The intercoupled instrument and instrument driver arewithdrawn. This involved movement of the carriage 552 in the oppositedirection. Next, indicated by box 432, is where the instrument andinstrument driver have reached the position illustrated in FIG. 13previously referred to as the “rest position”. In that position theinstrument driver (transporter) 550 is clear of the instrument storagechamber 540, and thus the instrument storage chamber 540 can be indexed(rotated). This is shown in FIG. 15 by the box 434. Following thesesteps, from FIG. 15 it is seen that there may be another registrationcheck (box 436), and a correction (box 438), in a manner similar to theoperation previously discussed regarding boxes 422 and 424. The processcan then repeat at a time determined by the surgeon's instrumentselection sequence.

There has to be some correlation between the indexing, what and whereparticular instruments are stored, and how the indexing is controlledfrom the master station. As indicated previously a foot switch can beused, such as the switch 410 illustrated in FIG. 10. In one version ofthe control the switch 410 may be comprised of six separate actuationbuttons, each one corresponding to one of the six instruments disposedin the instrument storage chamber 540. Indicia may be providedassociated with the storage chamber to indicate what particularinstrument is disposed in what particular instrument passage. In thisway the surgeon would know what button to actuate to select the desiredinstrument. There could be corresponding indicia associated with theswitch buttons so the surgeon knows what button corresponds exactly towhat instrument.

The control system for indexing may also include a decoding scheme sothat when the surgeon makes a selection the decoder determines thenumber of rotations (such as of the stepper motor 565) necessary tobring the instrument driver into proper registration with the selectedinstrument. Because it may not always be clear as to the specificinstrument sequence that the surgeon will use, the system has todetermine how to index from one instrument to the next one selected.This selection process involves more than just sequencing from oneinstrument to an adjacent instrument. The process will have toaccommodate a selection process in which the next selected instrument isnot the adjacent instrument. Thus a simple decoder can be used todetermine the number of stepper motor steps necessary to move thestorage chamber to the next selected instrument.

Another aid that can be provided to the surgeon is a visible displayillustrated in FIG. 10, and on which there can be a diagram that matchesthe storage chamber pattern showing to the surgeon exactly where eachinstrument is placed including the type of instrument. This could be setup when the instruments are first selected the disposed in theinstrument storage chamber 540. In association with this display onecould also provide, in place of the switch 410, a voice activated systemso that the surgeon simply indices by voice which instrument to select.This may be done by simply numbering the instruments, such as onethrough six. A further variation may use a touch screen so that thesurgeon simply touches an area on the screen corresponding to thedisplayed image of the storage chamber with the stored instruments. Inall of the above instances, there are electrical signals generated fromthe master station, through a touch screen, switch, etc. that areconveyed to the controller 9 and from there to the slave side. Theactivating signals at the slave side basically control the stepper motor565 via a cable set not specifically shown in the drawings but thatwould couple to the stepper motor 565 illustrated in FIGS. 11, 12 and14.

Reference is now made to FIG. 16 for a schematic representation of afurther alternate embodiment of the invention. In FIGS. 1 and 10 it isnoted that the instruments are contained in a parallel array. Inaccordance with the invention the instruments may also be disposed in aseries array, as depicted in the schematic diagram of FIG. 16. Thisembodiment includes a retainer 580 that is adapted to store a series ofinstruments 581 in a serial array, also referred to herein as a linearchamber or linear retainer. Means are provided to enable the array tomove laterally in the directions indicated by arrows 585. This movementcan be of either the retainer or the instruments themselves. There is analignment that occurs so that a selected instrument may align with aport 584 from which the instrument may then be moved to location 583.This is by a lateral or transverse movement of the instrument out of theretainer 580. This movement is indicated in FIG. 16 by the arrow 587.The instrument, once moved, is then in registration with the driver ortransporter 580 which is moveable in the direction of arrow 588. Thedriver is controlled as in previous embodiments to transition theinstrument to the operative site, through the represented output port586.

Although reference is made herein to “surgical instrument” it iscontemplated that the principles of this invention also apply to othermedical instruments, not necessarily for surgery, and including, but notlimited to, such other implements as catheters, as well as diagnosticand therapeutic instruments and implements.

Having now described certain embodiments of the present invention, itshould be apparent to one skilled in the art that numerous otherembodiments and modifications thereof can be made, some of which havealready been described, and all of which are intended to fall within thescope of the present invention. For example, the coupling sections orinterface sections have been disclosed as intercoupled cables with hookarrangements, such as shown in FIG. 6. In another arrangement adifferent mechanical coupling scheme may be employed using a differentinterlock between cables. Also, in place of mechanical couplings othertechnologies may be used for coupling action to the instrument and tool,such as SMA technology. Regarding the tool itself, one has beenillustrated with a wrist pivot. Instead the tool may include a bendablesection at or near its distal end. In place of the stepper motor otherindexing arrangements can be used, such as a ratchet and pawl system.Also, encoders can be used at the rotating storage chamber to detectmotions to provide feedback for controlling the overall system.

1. A medical instrument assembly, comprising: an instrument driverhaving a driver shaft, a driver cable slidably disposed through thedriver shaft, and a driver coupling member respectively mounted to thedriver cable; and an instrument configured for being mated with theinstrument driver, the instrument having an instrument shaft, an endeffector, an instrument cable slidably disposed through the instrumentshaft for actuating the end effector, and an instrument coupling memberrespectively mounted to the instrument cable, wherein the drivercoupling member and the instrument coupling member are configured forbeing releasably interlocked together.
 2. The medical instrumentassembly of claim 1, wherein the end effector is an articulating tool.3. The medical instrument assembly of claim 1, wherein the instrumentdriver has a plurality of driver cables slidably disposed through thedriver shaft, and a plurality of driver coupling members respectivelymounted to the driver cables, wherein the instrument has a plurality ofinstrument cables slidably disposed through the instrument shaft, and aplurality of instrument coupling members respectively mounted to theinstrument cables, and wherein driver coupling members and theinstrument coupling members are configured for being respectivelyreleasably interlocked together.
 4. The medical instrument assembly ofclaim 1, wherein each of the driver coupling member and the instrumentcoupling member has a hook.
 5. The medical instrument assembly of claim1, wherein the instrument driver has one of a post and a recess locatedon a distal surface of the driver shaft, and the instrument has anotherof the post and the recess on a proximal surface of the instrumentshaft, the post and recess configured for being mated together to alignthe driver coupling member with the instrument coupling member.
 6. Themedical instrument assembly of claim 1, wherein the instrument driverhas at least one slot on the driver shaft in which the driver couplingmember is disposed.
 7. The medical instrument assembly of claim 1,further comprising a storage chamber having a passage, wherein theinstrument driver is configured for being distally advanced within thepassage to engage the instrument and for being proximally retractedwithin the passage to disengage the instrument.
 8. The medicalinstrument assembly of claim 7, wherein the instrument coupling memberis configured for being biased radially outward, and the passage has asmall diameter distal section and a large diameter proximal section,whereby the small diameter distal section deflects the instrumentcoupling member radially inward to engage driver coupling member whenthe instrument driver is distally advanced within the passage, and thelarge diameter proximal section allows the instrument coupling member todeflect radially outward to disengage the driver coupling member whenthe instrument driver is proximally retracted within the passage.